| NPI | 1881229532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL M MARSHALL ALLEN Mgmr 813-777-1591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 163WW0000X Registered Nurse Wound Care |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2023-11-27 |